1. Field of the Invention
The invention relates to the field of apparatus and methods using computer-controlled rehabilitation or physical therapy in combination with a computer network. More specifically, the invention relates to an Internet-based rehabilitation system for treatment of injury and disease.
2. Description of the Prior Art
Stroke is the largest single cause of major disability in our nation with approximately 730,000 Americans having a new or recurrent stroke every year. As a result of their stroke, people often lose strength, speed, and coordination in their hand and arm or other motor functions. Post-stroke rehabilitation therapy is an important process in the recovery of stroke patients who, with practice, can for example improve their ability to reach, grasp, and manipulate objects. Although rehabilitation immediately after the stroke has more significant effects, improvements even several years after a brain injury are still possible. With the assistance of a physical or occupational therapist, stroke patients are able to improve their sensory motor skills by repetitive movements. These movements help stimulate recovery of the nervous system and aid the patient in relearning how to use their limbs.
With the high cost of medical care in the country today, many patients lack the monetary means to continue hands on therapy with a professional therapist for long periods of time. As a result, the patients are forced to go home earlier following their stroke without getting the post stroke therapy necessary for continued recovery. Further, there is a lack of technology to allow the patients to do their own therapy at home.
There are several examples of prior art systems that describe computer controlled rehabilitation or physical therapy in combination with a computer network. In general, these systems describe methods by which a rehabilitation therapist can interact with a remote patient in real-time. For example, Burgess, described below, teaches a method for providing physical therapy to a remote human client that includes a communication link that provides real-time sound and video images of the patient to the therapist, and vice versa. Girone et.al. and Hogan et.al., described below, teach telerehabilitation systems that are formed by a pair of rehabilitation devices with a first device at the therapist and a second device coupled to the client""s limbs. The therapist interacts in real-time with the patient by moving or feeling the movement of the first device, which moves or responds to the movement of the second device.
None of these prior art systems describe how a large number of patients could simultaneously access individualized therapy exercises remotely and autonomously from a therapist. This is significant because there is a very large number of survivors of stroke in the country who could benefit from ongoing rehabilitation exercise. Providing directly supervised therapy to this large population, even if it were done remotely, would be prohibitively costly. In addition, recent research has indicated that simple, highly repetitive exercise can improve sensory motor recovery. Such exercise can be performed without direct, moment-by-moment supervision of a therapist.
Recently, several robotic systems have been developed that physically interact with the patient to mimic the aid that would be provided by a real therapist and retrain coordinated movement (for example, see Hogan et al., below). Although preliminary trials show promise in the realms of improved evaluation and therapy, these robotic systems are not cost nor size efficient, making them impractical for common everyday home use.
Burgess, xe2x80x9cMethod and System for Providing Physical Therapy Services,xe2x80x9d U.S. Pat. No. 6,007,459 (1999) shows in FIG. 1, method 10 which includes the step 12 of providing an electronic communication link between a human client and a therapist that provides real-time video, sound, and data from the client to the therapist and vice versa. Step 14 of the method involves instructing the client to move in a particular manner or to assume a sustained posture. Further, the method includes step 16 involving the requesting of feedback from the client relating to bodily sensation corresponding to the movement or sustained posture. At step 20, the feedback is used to assess the physical condition of the client and at step 22, remedial movements or a remedial sustained posture is communicated to the client to address the physical condition.
As shown in FIG. 2, in response to a preliminary diagnosis, step 32 refers the client to an interactive terminal, which links the client and remotely located physical therapist through video images and sound. As shown in FIG. 3, system 40 includes a communication link 42, a first terminal 44 associated with a client and a second terminal 46 associated with a therapist.
As shown in FIG. 4, the system includes a goiniometer, an accelerometer, a dynamometer, reflex testing devices or other postural measurement devices coupled with the first terminal 4.
Burgess is described generally as being performed on xe2x80x9ca communication linkxe2x80x9d in which the therapist is remote from the patient, but interacting in real-time with the to patient.
Schenck et.al., xe2x80x9cTherapy Apparatus Having a Passive Motion Device for Flexing a Body Member,xe2x80x9d U.S. Pat. No. 5,746,704 (1998) describes an apparatus which is programmed or controlled to provide an upper range of motion or extension separated from a lower range of motion or flexion. When using device 10 to flex a finger 12, the device 10 can be supported to the patient""s wrist by a variety of means. As shown in FIG. 1, the slide guide 16 can be integral with a cast or wrist brace 92. Accordingly, the wrist brace 92 will be formed from a lightweight plastic material. To affix the finger 12 to the carriage 14, a connector 94, such as a rubber band or the like can be attached to the finger 12 and wrapped around the carriage 14, such as in an annular groove 96 formed in the outer surface 26 of the cylindrical carriage 14 intermediate the ends thereof.
Miller, xe2x80x9cExercise Apparatus,xe2x80x9d U.S. Pat. No. 5,755,645 (1998) shows an exercise apparatus, which when in use requires a user grasping limb interface 8 shown in FIGS. 1-3 can move limb interface 8 in the directions indicated by arrows D1-3 in a spherical configuration anywhere within the three dimensional resistance field 90 to exercise a full functional motion. Computer 110 can be programmed to provide resistance field 90 with separate areas of varied resistance. With reference to FIG. 3, limb interface 8 includes an outer yoke 120 which is secured to the distal end of arm member 18. An intermediate yoke 122 is rotatably mounted to outer yoke 120 along an axis 121 by rotary joints 128a and 128b. An inner yoke 124 is rotatably mounted to intermediate yoke 122 along an axis 123 by rotary joint 130. This configuration provides limb interface 8 with a gimbal joint 7 having three unbraked rotational degrees of freedom. The gimbal joint 7 allows the user""s hand to be comfortably oriented at almost any position relative to exercise apparatus 10 during use.
Girone et.al., xe2x80x9cAnkle Rehabilitation Systems,xe2x80x9d U.S. Pat. No. 6,162,189 (2000) shows in FIGS. 3A and 3B detailed views of the connection of foot attachment 24 to mobile platform 25 in rehabilitation device 12. Force sensor 36 is positioned between foot attachment 24 and mobile platform 25. Force sensor 36 measures in real time forces applied from foot 11 to mobile platform 25xe2x80x2. As shown in FIG. 5, controller interface 14 receives position measurement data 49 and force measurement data 39 from rehabilitation device 12. Position and force output 57 from analog-to-digital converter 56 is received at personal computer board 58. Pressure sensors 61 interface piston 42 of rehabilitation device 12 to generate piston pressure measurement data 60 from each compartment of piston 42.
Host computer 18 determines desired force and position measurement data 65 for rehabilitation device 12. Desired force and position measurement data 65 is applied to interface software module 66. Interface software module 66 determines, from sensor output 64 and desired force and position measurement data 65, the pressure to be applied to each piston 42 for providing desired force feedback and position of rehabilitation device 12. In FIG. 16, a real-time telerehabilitation system can be formed of a pair of rehabilitation devices with a first device at a therapist location and a second device coupled to the user""s foot. A therapist specialist 202 manipulates the local rehabilitation device 12b, which interfaces with the remote rehabilitation device 12a. Teleconferencing connection 210 connects host computer 18 and remote computer 23.
Lander et.al., xe2x80x9cTactile Feedback Controlled by Various Medium,xe2x80x9d U.S. Pat. No. 5,984,880 (1999) shows in FIG. 2, the system includes a first force-feedback assembly 1/15 comprising a force source 1 supplying the artificial hand 51 with a variable force value and a sensor 15 which monitors the hand movement. A digital word may be fed to the devices 51 and 52 by the computer 54 in some cases, thus producing an exact ratio or feedback between the force of device 51 and the force of device 52 depending upon the position constant of the force-feedback device 52 and the position constant of the artificial limb 51. Usually, the force of the force-feedback device 52 and the feedback of artificial limb 51 will be varied as a function of system forces, user interactive forces, virtual environment objects or a selected blend of these including computer 54 output.
Hogan et al., xe2x80x9cInteractive Robot Therapist,xe2x80x9d U.S. Pat. No. 5,466,213 (1995) shows in FIGS. 5a and 5b, the robotic therapist 10 to which patient 12 is secured can be controlled by a human physical therapist 112 who is interacting with robotic therapist 110. As a result, therapist 112 can remotely guide the patient 12. Robotic therapists 10 and 110 can optionally include cameras and sound systems 200 so that patient 12 and therapist 112 can see and talk to each other.
The invention is generally directed to an internet-based system for rehabilitation of sensory motor skills after brain injury or other injuries. More specifically the invention is a method and a system for remotely and simultaneously providing therapy services to a large number of human patients with sensory motor impairments through a computer network. The patients communicate to a server computer through the computer network from client computers. The server computer downloads individualized information to the client computer that specifies desired therapy and assessment exercises. The therapy and assessment exercises can be performed autonomously without real-time supervision from a therapist. Sensors connected to the client computer measure information about he patient""s sensory motor performance. A database on the server computer is updated based on the information from the computerized sensors. The information is analyzed on the server computer and the patients are given individualized, motivating feedback about their motor performance over days. Feedback can be given about how the patient""s abilities compare to statistical data form large groups of similar patients who have also used the system.
In the preferred embodiment, the computer network is the Internet, the server computer is a World Wide Web server, and the patient accesses therapy through a standard Web browser. The therapy and assessment exercises are Java applets that are downloaded and executed on the client computer through the Web Browser. The sensor connected to the client computer are mass-manufactured computer input devices, such as a computer mouse, a trackball, or a joystick. Active server pages transmit performance data to the server computer, where it is stored in a database. The patient, or a rehabilitation provider, can access the database through the Web browser to monitor the patient progress over time. Statistical computations can be performed on the server computer to provide patients with an analysis of their progress compared to other similar groups of patients.
The current implementation of the system uses a force feedback joystick to apply therapeutic patterns of force to the arm as the user plays video games, but the software can also be used with a variety of force-feedback and non-force feedback devices. It operates over the Internet using Java, and can track user movement recovery over time and report it to a remote location (e.g. a hospital), as well as back to the user (e.g. at home) for motivational and self-monitoring purposes. The system can also be customized to provide a personalized program of therapeutic exercise.
The current implementation of system makes use of custom software, a commercially available joystick (the Microsoft Sidewinder Force Feedback Pro), a commercially available arm rest (Ergorest), and a custom-designed clip-on handle.
Three principle features of the current system are
1) The methodology as controlled by JAVA software.
The software provides a series of simple movement games for the user (e.g. a stroke patient) to play that are downloaded to the user""s computer over the Internet through a Web Browser. It can track user movement recovery over time, storing performance data (e.g. changes in movement speed, accuracy, and smoothness) on a remote server. Thus, a clinician or the user can quantitatively monitor progress in regaining movement ability. Through the use of Java, the software is rapidly modifiable and customizable, and is structured to be platform independent. While Java software is described in the illustrated embodiment and is specifically set forth in the claims, it is to be expressly understood that any software that emulates the performance of Java software to the extent relative to the teachings of the invention is included within the scope of the invention and is within the meaning of the term, xe2x80x9cJavaxe2x80x9d, as used in this specification and its claims. The software is also independent of the particular input device, and can be used with a force feedback joystick, a mouse, or other input device. Currently arm rehabilitation is targeted, but the system could also be used with the hand, leg, neck and other body members or muscle groups.
2) Use of a commercial force feedback joystick as a personal movement trainer.
Large, expensive robots for physical rehabilitation of the arm after stroke have been developed by others and by the inventors in other applications. Such systems our bulky, and cost tens of thousands of dollars. The novel insight here was that a commercially available force-feedback gaming joystick, such as that produced by Microsoft, although other companies make similar devices, could be adapted to provide therapy. The joystick costs around $100, and with the software, arm rest, and clip-on handle, is the first viable force-feedback personal movement trainer for individuals after brain injury. However, a variety of other mass-manufactured computer input devices could also be used with the software.
3) The clip-on handle for the joystick.
The clip-on handle makes the system ergonomic for individuals with a brain injury. The handle does not require ability to grasp, and an individual with a one-sided impairment can attach his other hand to it without assistance.
The invention is more fully described in the detailed disclosure of the preferred embodiments. It""s primary features are:
1. The software as functionally defined in the disclosure for rehabilitation training;
2. Use of a conventional computer input device in rehabilitation training; and
3. The clip-on handle to the computer input device for those who cannot grasp the computer input device during rehabilitation training.
The present invention is an Internet-based rehabilitation system including, but not limited to, the following:
1. A web-based rehabilitation system and method which monitor rehabilitation status and provide a means to practice rehabilitation activities.
2. A system and method using a library of rehabilitation status tests and therapy activities.
3. A system and method which provide a means to display changes in sensory, motor, and/or cognitive status.
4. A system and method which provide a means to display each user""s frequency of use of the status tests and therapy activities.
5. A system and method which provide a means for therapists or caregivers to login and monitor patients ability and usage.
6. A system and method which provide a xe2x80x9cto-do-listxe2x80x9d of rehabilitation activities to accomplish.
7. A system and method which provide encouraging feedback to the user when the xe2x80x9cto-do-listxe2x80x9d is accomplished.
8. A system and method which provide a means for therapist or caregivers to customize the xe2x80x9cto-do-listxe2x80x9d.
While the apparatus and method has or will be described for the sake of grammatical fluidity with functional explanations, it is to be expressly understood that the claims, unless expressly formulated under 35 USC 112, are not to be construed as necessarily limited in any way by the construction of xe2x80x9cmeansxe2x80x9d or xe2x80x9cstepsxe2x80x9d limitations, but are to be accorded the full scope of the meaning and equivalents of the definition provided by the claims under the judicial doctrine of equivalents, and in the case where the claims are expressly formulated under 35 USC 112 are to be accorded full statutory equivalents under 35 USC 112. The invention can be better visualized by turning now to the following drawings wherein like elements are referenced by like numerals.